O51 – Environmental contact versus patient contact in the ICU: what do we touch?

Author(s):
S Swoboda, Rebecca Adelman, Pamela Lipsett, Johns Hopkins

Background: Hand hygiene (HH) for prevention of nosocomial infection has been the cornerstone for infection prevention for more than 20 years, however rates remain low. Recent emphasis on transmission of infection through contact with environmental surfaces has led to better efforts on daily and terminal cleaning. The CDC developed a checklist of “high touch surfaces” which include: bedrails, bedside table, iv pole and pump, doorknobs, toilet, light switch, chair, telephone, call bell, monitor touch screen, cables and ventilator control panel.

Hypothesis: ICU health care workers (HCW) differ in HH practices and in contact with “high touch surfaces” during patient interactions.

Methods: This was an observational study of HCW interactions in a surgical ICU on random weekdays. All contact with surfaces in the room and HH for each observation were recorded. Data analysis was performed as appropriate, p<0.05.

Results: 155 observations occurred over a 4 week period (49 MD and 106 RN observations). The majority of observations were in non-isolation patients for both groups (MD: 41 (83%), RN: 95 (90%). Only 48% MD and 81% RN performed entry and exit HH, p=0.01. Of the 49 MD encounters, 212 contacts occurred (4 contacts/interaction, range 0-18) and 1,058 contacts for RN’s (10 contacts/interaction, range 1-47), p =0.01. RN’s most frequently touched the patient (58%), IV lines (50%) and IV pumps (52%), the in room computer (44%), and the bedrail (43%). MD’s most frequently touched the patient (43%), the bedrail (36%), patient linen (26%) and the computer on wheels (12%). When compared to MD’s, RN’s were more likely to touch the supply cart, in room computer, monitor, glove box, IV pump and IV tubing, p<0.04. The percent of all interactions listed as CDC high touch zones was only 18%.

Conclusions: Despite decades of emphasis on HH, overall compliance for entry and exit HH is only 71%. Irrespective of HCW status, the majority of interactions are with environmental surfaces and not the patient, thus emphasizing the importance of environmental cleanliness. In our ICU, environmental surfaces are frequently touched by HCW, many of which are not part of the CDC surface cleaning checklist. Contact with environmental surfaces without HH may represent risk for disease transmission.